The usefulness of chromoendoscopy with methylene blue in Barrett’s metaplasia and early esophageal carcinoma

Örmeci, Necati; Savaş, Berna; Çoban, Şahin; Palabiyikoğlu, Murat; Ensarı, Arzu; Kuzu, Işınsu; Kurşun, Nazmiye

doi:10.1007/s00464-007-9463-x

Cited by 22 publications

(11 citation statements)

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“…The application of Lugol's iodine has been shown to improve visualisation of SCC and its pre-cancerous stage (Dawsey et al, 1998). Methylene blue has also been used to improve detection of dysplasia in Barrett's oesophagus, but subjectivity has meant results are difficult to reproduce (Ormeci et al, 2008), and there has been some concern over potential carcinogenicity of methylene blue (NTP, 2008).…”

Section: Chromoendoscopymentioning

confidence: 99%

Early diagnosis of oesophageal cancer

2009

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Squamous cell carcinoma and adenocarcinoma of the oesophagus are cancers that develop from distinct epithelial sub-types; however, they are both related to chronic inflammation of differing aetiologies. Inflammation leads to somatically inherited genetic mutations altering control of the cell cycle, DNA replication and apoptosis, which together result in autonomous and uncontrolled proliferation. These cancers have often metastasised to lymph nodes and distant organs before symptomatic presentation and therefore carry a poor prognosis. It is therefore vital to diagnose oesophageal cancer at an early stage, before the development of symptoms, when treatment can dramatically improve prognosis. Understanding the pathogenesis of these cancers is vital to guide early diagnostic strategies.

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Section: Chromoendoscopymentioning

confidence: 99%

Early diagnosis of oesophageal cancer

2009

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“…Although it was later replaced by other drugs, there is renewed interest for the treatment of malaria with MB [16]. Some of the other useful applications of MB include: treatment for methaemoglobinaemia recommended by the WHO and the European Commission as antidote [17]; attenuating the pathogenic effects of sepsis; sentinel lymph node biopsy (SLNB) to differentiate the different tissues [18]; chromoperturbation and chromoendoscopy to localise Barrett's metaplasia [19,20]; inhibition of the actions of nitric oxide that lead to increased blood pressure and myocardial function [21,22]; treatment of anaphylaxis [23][24][25] by giving intravenously 1.5-2 mg/kg body weight [26].In all the above clinical applications the final amount of MB in the patient is considerably higher than when using MB plasma. Nevertheless, the potential side-effect of treated plasma remains to be fully elucidated by active haemovigilance at national and European levels by main users.…”

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confidence: 99%

Main Properties of the THERAFLEX MB-Plasma System for Pathogen Reduction

Seghatchian¹,

Struff

Reichenberg

2011

Transfus Med Hemother

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Methylene blue (MB) treated plasma has been in clinical use for 18 years. The current THERAFLEX MB-Plasma has a number of improved features compared with the original Springe methodology. This overview embodies: the biochemical characteristics of MB, the mechanism of the technology, toxicology, pathogen reduction capacity, current position in clinical setting and status within Europe. The THERAFLEX MB (TMB) procedure is a robust, well standardised system lending itself to transfusion setting and meets the current guidelines. The pathogen kill power of the TMB system, like the other available technologies, is not limitless, probably in order of 6 log for most enveloped viruses and considerably less for non-enveloped ones. It does not induce either new antigen or grossly reducing the function and life span of active principle in fresh frozen plasma (FFP). The removal of the residual MB at the end of the process has the beneficial effect of reducing potential toxic impacts. Clinical haemovigilance data, so far, indicate that cell-free MB plasma is effective in all therapeutic setting requiring FFP, besides inconsistent thrombotic thrombocytopenia purpura data, without serious side-effects or toxicity. The current system is in continuous improvement e.g. regarding virus reduction range, illumination device, software used, and process integration in the blood bank setting.

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“…In one of the trials, the blinding method was inappropriate, and the interval between two endoscopies, the washout period, was considered insufficient 19,23]. In another trial, the included patients were not necessarily diagnosed with Barrett's esophagus, and both RB and MBDB were performed on the same endoscopy, one after the other [20]. One of the clinical trials written in Portuguese was not randomized, and another trial compared the results of the intervention group (MBDB) with those of a historical control group (RB) [21,22].…”

Section: Methodsmentioning

confidence: 99%

“…Four of the clinical trials lacked randomization, crossover, and blinding [19][20][21][22]. In one of the trials, the blinding method was inappropriate, and the interval between two endoscopies, the washout period, was considered insufficient 19,23].…”

Section: Methodsmentioning

confidence: 99%

A meta-analysis of randomized controlled trials comparing methylene blue-directed biopsies with random biopsies in the surveillance of Barrett’s esophagus

Admad

Ahmed

2010

Esophagus

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A meta-analysis of randomized controlled trials comparing methylene blue-directed biopsies with random biopsies in the surveillance of Barrett's esophagus Abstract This study was designed to examine the shortfalls of methylene blue-directed biopsies (MBDB) and conventional random biopsies (RB) in the surveillance of Barrett's esophagus. A Cochrane and Medline search was performed, and fi ve randomized controlled trials (RCTs) comprising 213 patients were selected for the meta-analysis. Random biopsies failed to spot specialized intestinal metaplasia (SIM) in a signifi cantly higher number of patients than MBDB (risk ratio, 0.724; confi dence interval, 0.552-0.950). The rate of underdiagnosis of dysplasia was comparable between the two techniques (risk ratio, 0.766; confi dence interval, 0.273-2.147). More biopsies were obtained using the RB technique, and a signifi cantly higher number of biopsies was reported as normal in comparison to MBDB (P = 0.014). The use of endoscopic staining was associated with prolongation of the procedure time (P = 0.009). It was concluded that SIM is overlooked more often in conventional biopsy techniques, but the incidence of undetected dysplasia is comparable using both methods. The routine use of methylene blue in the surveillance of Barrett's esophagus seems to be unnecessary.

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The usefulness of chromoendoscopy with methylene blue in Barrett’s metaplasia and early esophageal carcinoma

Abstract: Chromoendoscopy is useful for delineating Barrett's epithelium and for indicating the correct location for securing biopsies where dysplasia or early esophageal cancer is suspected.

Cited by 22 publications

References 50 publications

Early diagnosis of oesophageal cancer

Early diagnosis of oesophageal cancer

Main Properties of the THERAFLEX MB-Plasma System for Pathogen Reduction

A meta-analysis of randomized controlled trials comparing methylene blue-directed biopsies with random biopsies in the surveillance of Barrett’s esophagus

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